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Orthostatic hypotension, also known as postural hypotension, [2] is a medical condition wherein a person's blood pressure drops when they are standing up (orthostasis) or sitting down. Primary orthostatic hypotension is also often referred to as neurogenic orthostatic hypotension. [ 3 ]
Effective treatment depends on determining the underlying etiology and instituting appropriate interventions to reduce the risk of harm to the patient. If the history suggests neurogenic orthostatic hypotension as a cause of syncope, a definitive diagnosis may require a complete autonomic workup and coordination of care between the primary care ...
Orthostatic hypotension [1] leading to dizziness and fainting; Oily skin [25] Urinary incontinence [1] (typically in later disease progression) and nocturia (getting up in the night to pass urine) Altered sexual function [1] is characterized by profound impairment of sexual arousal, behavior, orgasm, and drive, and is found in mid- and late PD.
Midodrine is indicated for the treatment of symptomatic orthostatic hypotension. It can reduce dizziness and faints by about a third, but can be limited by troublesome goose bumps, skin itch, gastrointestinal discomfort, chills, elevated blood pressure while lying down, and urinary retention. [7]
Orthostatic vital signs are also taken after surgery. [7] A patient is considered to have orthostatic hypotension when the systolic blood pressure falls by more than 20 mm Hg, the diastolic blood pressure falls by more than 10 mm Hg, or the pulse rises by more than 20 beats per minute within 3 minutes of standing [5] [7]
If the noxious stimuli cannot be identified or the systolic blood pressure remains above 150 mmHg, then pharmacologic treatment may be needed. [27] In this situation, the aim is to decrease the elevated intracranial pressure until further studies can identify the cause. [28] Pharmacologic treatment will include antihypertensive medications.
Within three minutes of standing up straight, orthostatic hypotension is defined as a drop in systolic blood pressure of at least 20 mm Hg or a drop in diastolic blood pressure of 10 mm Hg. [7] About half of PAF patients also have concurrent supine hypertension, even though all PAF patients by definition have orthostatic hypotension. [8]
Recommended acute treatment of vasovagal and orthostatic (hypotension) syncope involves returning blood to the brain by positioning the person on the ground, with legs slightly elevated or sitting leaning forward and the head between the knees for at least 10–15 minutes, preferably in a cool and quiet place.